Comparative analysis of ChatGPT, Gemini and emergency medicine specialist in ESI triage assessment.

INTRODUCTION: The term Artificial Intelligence (AI) was first coined in the 1960s and has made significant progress up to the present day. During this period, numerous AI applications have been developed. GPT-4 and Gemini are two of the best-known of these AI models. As a triage system The Emergency Severity Index (ESI) is currently one of the most commonly used for effective patient triage in the emergency department. The aim of this study is to evaluate the performance of GPT-4, Gemini, and emergency medicine specialists in ESI triage against each other; furthermore, it aims to contribute to the literature on the usability of these AI programs in emergency department triage. METHODS: Our study was conducted between February 1, 2024, and February 29, 2024, among emergency medicine specialists in Turkey, as well as with GPT-4 and Gemini. Ten emergency medicine specialists were included in our study but as a limitation the emergency medicine specialists participating in the study do not frequently use the ESI triage model in daily practice. In the first phase of our study, 100 case examples related to adult or trauma patients were extracted from the sample and training cases found in the ESI Implementation Handbook. In the second phase of our study, the provided responses were categorized into three groups: correct triage, over-triage, and under-triage. In the third phase of our study, the questions were categorized according to the correct triage responses. RESULTS: In the results of our study, a statistically significant difference was found between the three groups in terms of correct triage, over-triage, and under-triage (p < 0.001). GPT-4 was found to have the highest correct triage rate with an average of 70.60 (±3.74), while Gemini had the highest over-triage rate with an average of 35.2 (±2.93) (p < 0.001). The highest under-triage rate was observed in emergency medicine specialists (32.90 (±11.83)). In the ESI 1-2 class, Gemini had a correct triage rate of 87.77%, GPT-4 had 85.11%, and emergency medicine specialists had 49.33%. CONCLUSION: In conclusion, our study shows that both GPT-4 and Gemini can accurately triage critical and urgent patients in ESI 1&2 groups at a high rate. Furthermore, GPT-4 has been more successful in ESI triage for all patients. These results suggest that GPT-4 and Gemini could assist in accurate ESI triage of patients in emergency departments.

Effect of tumor-infiltrating immune cells (mast cells, neutrophils and lymphocytes) on neoadjuvant chemotherapy response in breast carcinomas.

INTRODUCTION: Despite screening, the incidence of breast cancer is increasing worldwide. Neoadjuvant chemotherapy (NAC) response is one of the most important parameters taken into consideration in surgery, optimal adjuvant chemotherapy planning and prognosis prediction. Research on predictive markers for the response to NAC is still ongoing. In our study, we investigated the relationship between tumor-infiltrating neutrophils/mast cells/lymphocytes and NAC response in breast carcinomas. MATERIAL AND METHOD: Study included 117 patients who were diagnosed with invasive breast carcinoma using core needle biopsy. In these biopsies tumor-infiltrating neutrophils/mast cells/lymphocytes were evaluated and Miller Payne Score was used for NAC response. RESULT: 53 patients exhibited high TILs, 36 had high TINs, and 46 showed high TIMs. While pathological complete response was 27 % in all patients, it was 38 % in high TINs patients, 35 % in high TILs patients, and 28 % in high TIMs patients. High TIMs were observed to be statistically associated with survival. TILs, TINs, nuclear grade, ER, PR and HER2 expression, Ki-67 proliferation index were found to be associated with the Miller - Payne score. In multivariate analysis, TINs, nuclear grade, pathological stage, and molecular subtype were found to be independent risk factors for treatment response. CONCLUSION: TINs have better prognostic value to predict neoadjuvant treatment than TILs. High TIMs are associated with increased overall survival. The inclusion of TINs in NAC response and TIMs in overall survival in pathology reports and treatment planning is promising in breast carcinomas as they are simple to use and reproducible markers.

Comparison of emergency medicine specialist, cardiologist, and chat-GPT in electrocardiography assessment.

INTRODUCTION: ChatGPT, developed by OpenAI, represents the cutting-edge in its field with its latest model, GPT-4. Extensive research is currently being conducted in various domains, including cardiovascular diseases, using ChatGPT. Nevertheless, there is a lack of studies addressing the proficiency of GPT-4 in diagnosing conditions based on Electrocardiography (ECG) data. The goal of this study is to evaluate the diagnostic accuracy of GPT-4 when provided with ECG data, and to compare its performance with that of emergency medicine specialists and cardiologists. METHODS: This study has received approval from the Clinical Research Ethics Committee of Hitit University Medical Faculty on August 21, 2023 (decision no: 2023-91). Drawing on cases from the "150 ECG Cases" book, a total of 40 ECG cases were crafted into multiple-choice questions (comprising 20 everyday and 20 more challenging ECG questions). The participant pool included 12 emergency medicine specialists and 12 cardiology specialists. GPT-4 was administered the questions in a total of 12 separate sessions. The responses from the cardiology physicians, emergency medicine physicians, and GPT-4 were evaluated separately for each of the three groups. RESULTS: In the everyday ECG questions, GPT-4 demonstrated superior performance compared to both the emergency medicine specialists and the cardiology specialists (p < 0.001, p = 0.001). In the more challenging ECG questions, while Chat-GPT outperformed the emergency medicine specialists (p < 0.001), no significant statistical difference was found between Chat-GPT and the cardiology specialists (p = 0.190). Upon examining the accuracy of the total ECG questions, Chat-GPT was found to be more successful compared to both the Emergency Medicine Specialists and the cardiologists (p < 0.001, p = 0.001). CONCLUSION: Our study has shown that GPT-4 is more successful than emergency medicine specialists in evaluating both everyday and more challenging ECG questions. It performed better compared to cardiologists on everyday questions, but its performance aligned closely with that of the cardiologists as the difficulty of the questions increased.

A Comparison of 18 F-FDG PET/CT and 68 Ga-PSMA PET/CT in Detecting Osteonecrosis of the Jaw in a Patient With Prostate Cancer.

ABSTRACT: Medication-related osteonecrosis of the jaw (ONJ) is rare adverse effect of zoledronic acid. We present ONJ detected in a 65-year-old man with prostate cancer who underwent 18 F-FDG PET/CT for metabolic characterization and to exclude a second primary malignancy of the liver lesion observed in 68 Ga-PSMA PET/CT. ONJ has high metabolic activity on 18 F-FDG PET/CT and no PSMA receptor activation on the 68 Ga-PSMA PET/CT. In this case, we wanted to underline the importance of 18 F-FDG PET/CT imaging of medication-related ONJ in patients receiving zoledronic acid therapy and to emphasize that rapid and appropriate treatment can be provided.

Production of alginate macrocapsule device for long-term normoglycaemia in the treatment of type 1 diabetes mellitus with pancreatic cell sheet engineering.

Type 1 diabetes-mellitus (T1DM) is characterized by damage of beta cells in pancreatic islets. Cell-sheet engineering, one of the newest therapeutic approaches, has also been used to create functional islet systems by creating islet/beta cell-sheets and transferring these systems to areas that require minimally invasive intervention, such as extrahepatic areas. Since islets, beta cells, and pancreas transplants are allogeneic, immune problems such as tissue rejection occur after treatment, and patients become insulin dependent again. In this study, we aimed to design the most suitable cell-sheet treatment method and macrocapsule-device that could provide long-term normoglycemia in rats. Firstly, mesenchymal stem cells (MSCs) and beta cells were co-cultured in a temperature-responsive culture dish to obtain a cell-sheet and then the cell-sheets macroencapsulated using different concentrations of alginate. The mechanical properties and pore sizes of the macrocapsule-device were characterized. The viability and activity of cell-sheets in the macrocapsule were evaluatedin vitroandin vivo. Fasting blood glucose levels, body weight, and serum insulin & C-peptide levels were evaluated after transplantation in diabetic-rats. After the transplantation, the blood glucose level at 225 mg dl-1on the 10th day dropped to 168 mg dl-1on the 15th day, and remained at the normoglycemic level for 210 days. In this study, an alginate macrocapsule-device was successfully developed to protect cell-sheets from immune attacks after transplantation. The results of our study provide the basis for future animal and human studies in which this method can be used to provide long-term cellular therapy in T1DM patients.

Prognostic Value of Inflammation And Nutrition-Based Scores in Non-Small Cell Lung Cancer.

OBJECTIVE: In studies conducted on non-small cell lung cancer (NSCLC) patients, many factors such as age, stage, weight loss, lymph node, and pleural involvement have been shown to affect survival. On the other hand, systemic inflammation plays a critical role in proliferation, migration, invasion, and metastasis. Inflammation and nutrition-based prognostic scores are reported to be associated with survival in patients with NSCLC. The aim of our study is to show the effects of these scores on survival and disease progression in NSCLC patients. SUBJECTS AND METHODS: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), modified Glasgow prognostic score (mGPS), and prognostic nutritional index (PNI) values in 102 patients with stage 1,2 and 3A NSCLC were analyzed retrospectively. RESULTS: NLR (p < 0.001), PLR (p = 0.001), PNI (p < 0.001), and mGPS (p = 0.001) variables showed a statistically significant difference according to mortality groups. NLR and PLR values were higher in exitus patients. However, PNI values were higher in surviving patients. NLR (p < 0.001), PLR (p = 0.004), PNI (p = 0.001), and mGPS (p = 0.015) variables showed a statistically significant difference in terms of locoregional recurrence. PNI (p = 0.001) and mGPS (p = 0.001) in terms of distant metastasis development during follow-up and treatment, showed a statistically significant difference. CONCLUSION: NLR, PLR, PNI, and mGPS are easily accessible and non-invasive parameters and provide predictive information about survival and disease course. We showed the effect of these parameters on the prognosis.

Examining the effect of activated cytotoxic (CD8+) T-cell exosomes to the lung cancer.

Lung cancer continues to be a major health problem worldwide owing to its incidence, and causes physical, psychological, social, and economic problems. Activated cytotoxic T cells (ACTC) are positively correlated with the tumor microenvironment (TME), improving the prognosis of cancer patients. Recently, ACTC-derived exosomes (ACTC-dExo) were implicated in this effect by inhibiting mesenchymal stem cells, which may promote metastasis in the TME. Exosomes are thought to be advantageous for the specific delivery of drugs to cancer cells because they have the characteristics of natural liposomes, are nanosized, and remain largely stable in the blood due to the protein and lipid content they carry on their membranes. In this study, we aimed to determine the cytotoxic and metastatic inhibitory effects of ACTC-dExo in A549 cells in vitro. Cytotoxic CD8+ T cells were isolated from whole blood obtained from healthy individuals and cultured for 5-7 days after stimulation. The ACTC-dExo serum-free culture medium was collected by ultracentrifugation. Characterization and quantification of the isolated exosomes were performed using flow cytometry, electron microscopy, zeta-sizer measurements, and bicinchoninic acid (BCA) assays. We co-cultured ACTC and ACTC-dExo with A549 cells for 48 h. The viability of A549 cells was evaluated using a WST-1 assay. The metastasis-related genes MMP2, MMP9, TWIST, SNAI1, and CDH1 were detected by qRT-PCR, and MMP2 and MMP9 proteins were evaluated by confocal microscopy. In addition, changes in cell migration were investigated using a scratch assay. ACTC-dExo were found to have anti-proliferative and anti-metastatic effects and reduced cancer cell proliferation and metastatic properties.

Investigation of impacts of decellularized heart extracellular matrix and VEGF on cardiomyogenic differentiation of mesenchymal stem cell through Notch/Hedgehog signaling pathways.

OBJECTIVE: Decellularization is the process to obtain natural scaffolds with tissue integrity and extracellular matrix components, and recellularization is used to produce tissue-like constructs with specific cell types. In this study, rat bone marrow-derived mesenchymal stem cells (rBM-MSCs) were cultured on decellularized heart extracellular matrix. These cells were then induced to differentiate into cardiomyogenic cells under the stimulatory effect of vascular endothelial growth factor (VEGF) and other chemicals. This study aimed to investigate the effect of the cardiac extracellular matrix and VEGF on cardiomyogenic differentiation in the context of the Notch and Hedgehog signaling pathways. METHODS: Heart samples extracted from rats were decellularized by serial application of detergent to remove cells from the tissue, and then recellularized with rBM-MSCs. The recellularized tissue matrices were then analyzed for cardiomyogenesis. Cardiomyogenic differentiation was performed on decellularized heart extracellular matrix (ECM; three-dimensional scaffolds) and culture plates (two-dimensional cell culture system) for 28 days to understand the effects of the heart extracellular matrix. In addition, differentiation was induced with and without the stimulatory effect of VEGF to understand the effect of VEGF on cardiomyogenic differentiation of rBM-MSCs. RESULTS: Immunofluorescence staining showed that decellularization of the heart was performed effectively and successfully. After decellularization process, the heart extracellular matrix was completely free of cells. It was observed that rBM-MSCs transplanted onto the heart extracellular matrix remained viable and proliferated for 21 days after recellularization. The rBM-MSCs promoted cardiomyogenic differentiation in the conventional differentiation medium but were inversely affected by both VEGF and heart extracellular matrix proteins. Lower expression of connexin43 and cardiac troponin I genes was observed in cells induced by either matrix proteins or VEGF, compared to cells differentiated by chemical agents alone. CONCLUSION: In this study, we investigated the effect of decellularized heart extracellular matrix and VEGF on cardiomyogenic differentiation of rBM-MSCs. On the decellularized cardiac extracellular matrix, rBM-MSCs maintained their viability by adhering to the matrix and proliferating further. The adhesion of the cells to the matrix also produced a physical stimulus that led to the formation of histological structures resembling myocardial layers. Chemical stimulation of the decellularized heart extracellular matrix and cardiomyogenic differentiation supplements resulted in increased expression of cardiomyogenic biomarkers through modulation of the Notch and Hedgehog signaling pathways.

Investigation of the effect of pancreatic decellularized matrix on encapsulated Islets of Langerhans with mesenchymal stem cells.

OBJECTIVE: In this study, it was aimed to provide a therapeutic approach for T1DM by encapsulating the pancreatic islets with mesenchymal stem cells and decellularized pancreatic extracellular matrix to support the survival of islets while maintaining their cellular activity. METHOD: Pancreatic extracellular matrix was decellularized using different concentrations of detergent series. After the preparation of the protein-based tissue extracellular matrix was shown to be free of cells or any genetic material by molecular, immunofluorescence and histochemical techniques. Following the homogenization of the decellularized pancreatic extracellular matrix and the analysis of its protein composition by LC-MS, the matrix proteins were incorporated with pancreatic islets and rat adipose tissue-derived MSCs (rAT-MSCs) in alginate microcapsules. Glucose-stimulated insulin secretion property of the islet cells in the microbeads was evaluated by insulin ELISA. The gene expression profile of the encapsulated cells was analyzed by Real-Time PCR. RESULTS: Unlike the protein composition of whole pancreatic tissue, the decellularized pancreas matrix was free of histone proteins or proteins originated from mitochondria. The protein matrix derived from pancreatic tissue was shown to support the growth and maintenance of the islet cells. When compared to the non-encapsulated pancreatic islet, the encapsulated cells demonstrate to be more efficient in terms of insulin expression. CONCLUSION: The extracellular pancreatic matrix obtained in this study was directly used as supplementary in the alginate-based microcapsule enhancing the cell survival. The tissue matrix protein and alginate had a synergistic effect on total insulin secretion, which might have the potential to overcome the insulin deficiency. Despite the improvement in the cell viability and the number, the efficiency of the insulin secretion in response to glucose stimulation from the alginate microcapsules did not meet the expectation when compared with the non-encapsulated pancreatic islets.

The anti-scar effect of tyrosine-kinase inhibitor nintedanib in experimental glaucoma filtration surgery in rabbits.

PURPOSE: To investigate the efficacy of nintedanib on preventing postoperative scar in formation following glaucoma filtering surgery (GFC) in rabbits in comparison with Mitomycin-C (MMC). DESIGN: Experimental Animal Study. METHODS: 24 New Zealand rabbits were divided randomly into 3 groups as Sham, Nindetanib and MMC(n = 8). Limbal-based trabeculectomy was performed on the right eyes of the rabbits. Left eyes that did'nt undergo surgery were included in the control group (n = 8). Following surgery, Intraocular pressures (IOP), postoperative complications and morphological changes in the bleb were evaluated. On the 28th day, eight eyes from each group were enucleated and histologically and immunohistochemically analyzed. Matrix metalloproteinase-2 (MMP-2), Transforming Growth Factor-1 (TGF-B1) and alpha-smooth muscle actin (a-SMA) were evaluated. RESULTS: It was observed that nintedanib has no side effects and reduces subconjunctival fibrosis. Postoperative IOP values in the Nindetanib group were lower than the other groups (p < 0.05). The longest bleb survival was observed in the Nintedanib group and the shortest in the Sham group (p < 0.001). Conjunctival vascularity and inflammation was reduced in the Nintedanib group compared to the Sham group (p < 0.05). The highest subconjunctival fibrosis was observed in the Sham group and the least in the Nintedanib group (p < 0.05). Although the fibrosis score was found lower in the Nintedanib group compared to the MMC(p > 0.05). α-SMA TGF-ß1, MMP-2 expressions were similar in Nintedanib and MMC groups (p > 0.05), however, it was observed that significantly decreased in both groups compared to Sham group (p < 0.05). CONCLUSION: It has been observed that Nindetanib suppress fibroblast proliferation Thus, It may be a drug that can prevent subconjunctival fibrosis in GFC.

Differentiation of Benign and Malignant Thyroid Nodules with ANFIS by Using Genetic Algorithm and Proposing a Novel CAD-Based Risk Stratification System of Thyroid Nodules.

The thyroid nodule risk stratification guidelines used in the literature are based on certain well-known sonographic features of nodules and are still subjective since the application of these characteristics strictly depends on the reading physician. These guidelines classify nodules according to the sub-features of limited sonographic signs. This study aims to overcome these limitations by examining the relationships of a wide range of ultrasound (US) signs in the differential diagnosis of nodules by using artificial intelligence methods. An innovative method based on training Adaptive-Network Based Fuzzy Inference Systems (ANFIS) by using Genetic Algorithm (GA) is used to differentiate malignant from benign thyroid nodules. The comparison of the results from the proposed method to the results from the commonly used derivative-based algorithms and Deep Neural Network (DNN) methods yielded that the proposed method is more successful in differentiating malignant from benign thyroid nodules. Furthermore, a novel computer aided diagnosis (CAD) based risk stratification system for the thyroid nodule's US classification that is not present in the literature is proposed.

The Effects of Transcranial Focused Ultrasound Stimulation of Nucleus Accumbens on Neuronal Gene Expression and Brain Tissue in High Alcohol-Preferring Rats.

We investigated the effect of low-intensity focused ultrasound (LIFU) on gene expression related to alcohol dependence and histological effects on brain tissue. We also aimed at determining the miRNA-mRNA relationship and their pathways in alcohol dependence-induced expression changes after focused ultrasound therapy. We designed a case-control study for 100 days of observation to investigate differences in gene expression in the short-term stimulation group (STS) and long-term stimulation group (LTS) compared with the control sham group (SG). The study was performed in our Experimental Research Laboratory. 24 male high alcohol-preferring rats 63 to 79 days old, weighing 270 to 300 g, were included in the experiment. LTS received 50-day LIFU and STS received 10-day LIFU and 40-day sham stimulation, while the SG received 50-day sham stimulation. In miRNA expression analysis, it was found that LIFU caused gene expression differences in NAc. Significant differences were found between the groups for gene expression. Compared to the SG, the expression of 454 genes in the NAc region was changed in the STS while the expression of 382 genes was changed in the LTS. In the LTS, the expression of 32 genes was changed in total compared to STS. Our data suggest that LIFU targeted on NAc may assist in the treatment of alcohol dependence, especially in the long term possibly through altering gene expression. Our immunohistochemical studies verified that LIFU does not cause any tissue damage. These findings may lead to new studies in investigating the efficacy of LIFU for the treatment of alcohol dependence and also for other psychiatric disorders.

Triponderal mass index is as strong as body mass index in the determination of obesity and adiposity.

OBJECTIVE: In determining obesity and body adiposity, triponderal mass index (TMI) is as strong an anthropometric measurement as body mass index (BMI). The aim of this study was to develop TMI reference values for Turkish children and adolescents and compare TMI with BMI according to body adiposity and obesity indices. METHODS: Data from the DAMTCA-II (Determination of Anthropometric Measurements of Turkish Children and Adolescents II) study were used in this cross-sectional study. Data from 4330 children (1931 boys, 2399 girls) ages 6 to 17 y were evaluated, and the TMI percentile values were produced. The predictive power of TMI and BMI for obesity and overweight were done for waist circumference, waist/height ratio, body fat percentage, and upper arm fat area, which are different parameters used to determine body adiposity. RESULTS: The 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, and 97th TMI percentiles and mean values were calculated for all children's age and sex. TMI cutoff values were calculated by receiver operating characteristic analysis regarding waist/height ratio 0.5, waist circumference ≥90 percentile, arm fat area ≥85 percentile, and body fat percentage ≥85. TMI and BMI area under the curve values were similar for each of these four measurements. TMI was as robust an index as BMI in demonstrating obesity and adiposity for all age groups in boys and girls. It was concluded that the values >90th percentile (median 15.8 kg/m3) in girls aged ≤10 y, 95th percentile (median 16.2 kg/m3) in girls aged >10 y, >85th percentile (median 14.9 kg/m3) in boys aged ≤12 y and 75th percentile (median value 14.5 kg/m3) in boys aged >12 y are critical values for TMI when evaluating adiposity and obesity. CONCLUSIONS: We considered that TMI is as effective as BMI in terms of waist/height ratio, waist circumference, arm fat area, and body fat percentage in determining overweight and obesity in children. The ages at which TMI showed distinct variation were determined for both sexes.

Computed Tomographic Thickness of Retrobulbar Optic Nerve Is Decreased in Glaucoma Patients and Is Negatively Correlated With Disease Severity.

Purpose The purpose of the study was to quantitatively measure the width of the retrobulbar optic nerve-sheath complex by computed tomography (CT) in glaucoma and evaluate its relationship with optic nerve changes and visual field loss parameters. Methods Sixty-six eyes of 33 patients with bilateral asymmetric glaucomatous optic nerve damage and 20 eyes of 20 age- and sex-matched control subjects without glaucoma were included. Axial retrobulbar optic nerve-sheath complex was measured by CT in the eyes with advanced glaucomatous damage (group 1); in the fellow eyes of the same patients with moderate glaucomatous damage (group 2); and in control subjects (group 3). Measurements were obtained at three different points: just behind the globe, near the optic canal, and in the middle. Results Mean age and sex distribution between groups were comparable (p>0.05). The mean diameters of the retrobulbar optic nerve at three measurement points in group 1 (4.00±0.42mm, 3.49±0.44mm, 3.18±0.45mm) were significantly (for each, p<0.05) lower when compared with the corresponding points of group 2 eyes (4.24±0.41mm, 3.77±0.47nn, 3.47mm±0.44mm) and normal controls (4.58±0.44mm, 4.15±0.45mm, 3.92±0.48mm). Optic disc changes and visual field parameters were negatively correlated with retrobulbar optic nerve diameter (for each, p < 0.05). Conclusion Radiological alterations of the retrobulbar optic nerve in glaucomatous eyes revealed a decreased optic nerve diameter which correlated with disease severity. Optic nerve dimensions below the lower limit for normal individuals may be considered pathologically reduced and, therefore, CT measurements of the retrobulbar nerve may be additive to the traditional triad of raised intraocular pressure, field defects, and optic disc changes in some cases with opaque optic media preventing the fundus examination or with optic nerve anomalies.

Association Between Eating Disorder Risk and Family Structure and Social Appearance Anxiety Among College Freshman.

Objective: Eating disorders can be described as continuous eating or eating-related behavior disorders that are detrimental to health or psychosocial function. The present study determines the association between eating disorder risk and family structure and social appearance anxiety among college freshman. Method: This cross-sectional study was carried out among 683 freshman based on socio-demographic data, Eating Attitude Test, a Family Structure-System Assessment Device comprising 36 questions and a Social Appearance Anxiety Scale. Results: A risk of eating disorders was identified in 10.2% of the participants. In the analysis, female gender (P = .013), young age (P = .022), presence of social appearance anxiety (P = .010), and a negatively defined family structure (P = .022) were found to increase the risk of eating disorders. Conclusions: Family structures should be considered when screening for young people at risk of eating disorders.

A family of C. elegans VASA homologs control Argonaute pathway specificity and promote transgenerational silencing.

Germline Argonautes direct transcriptome surveillance within perinuclear membraneless organelles called nuage. In C. elegans, a family of Vasa-related Germ Line Helicase (GLH) proteins localize in and promote the formation of nuage. Previous studies have implicated GLH proteins in inherited silencing, but direct roles in small-RNA production, Argonaute binding, or mRNA targeting have not been identified. Here we show that GLH proteins compete with each other to control Argonaute pathway specificity, bind directly to Argonaute target mRNAs, and promote the amplification of small RNAs required for transgenerational inheritance. We show that the ATPase cycle of GLH-1 regulates direct binding to the Argonaute WAGO-1, which engages amplified small RNAs. Our findings support a dynamic and direct role for GLH proteins in inherited silencing beyond their role as structural components of nuage.

The therapeutical effects of damage-specific stress induced exosomes on the cisplatin nephrotoxicity IN VIVO.

Cisplatin is one of the metal containing drugs for the solid cancer treatments. However, its side-effects limit its application in the cancer treatment. Stem cell therapy is a promising treatment for the tissue damage caused by the chemotherapeutic agents, like cisplatin. Exosomes secreted by mesenchymal stem cells (MSCs) could be used for cell-free regenerative treatment, but their potency and reproducibility are questionable. In this study, the microenvironment of the renal tubular epithelial cells was mimicked by coculture of endothelial-, renal proximal tubule epithelial- and fibroblast cells. Cisplatin was applied to this tricell culture model, and the secreted rescue signals were collected and used to induce MSCs. From these stress-induced MSCs, the (stress-induced) exosomes were collected and used for the cell-free therapeutic treatment of cisplatin-treated rats with acute kidney injury. The composition of the stress-induces exosomes was compared with the non-induced exosomes and found that the expression of some critical factors for cell proliferation, repair mechanism and oxidative stress was improved. The cisplatin-damaged renal tissue showed substantial recovery after the treatment with stress-induced exosomes compared to the treatment with non-induced exosomes. Although, the non-induced exosomes showed their activity mostly as cytoprotective, the induced exosomes further involved actively in the tissue regeneration, like MSCs. It was shown that the exosomes could be reprogrammed to improve their therapeutic effect to be used in cell-free regenerative medicine. Further, cisplatin-induced tissue damage in the kidney might be effectively prevented and used for tissue regeneration by use of induced exosomes generated for a particular damage.

Children's Perioperative Multidimensional Anxiety Scale (CPMAS): Turkish Validity and Reliability Study.

PURPOSE: To test the validity and reliability of the Turkish version of the Children's Perioperative Multidimensional Anxiety Scale (CPMAS). DESIGN: Methodological research model. METHODS: One hundred children (81% male) aged 7 to 13 years undergoing elective surgery at a tertiary university hospital were included. Self-administered CPMAS and State-Trait Anxiety Inventory-Children were used to collect data at preoperative, operation day, and a month after the operation. Internal consistency, test-retest reliability, parallel form reliability, and content and construct validity of the tools were determined across all three visits. FINDINGS: The CPMAS demonstrated good test-retest reliability (ICC = 0.51 to 0.78) and good internal consistency (Cronbach's alpha = 0.78 to 0.81). Inter item correlation values were ranged from 0.20 to 0.62 at preoperative, 0.32 to 0.64 on the day of operation and 0.36 to 0.75 at a month after the operation. CPMAS single-factor construct and the explanatory percentages were 0.54 and above. After Pearson correlation analysis, CPMAS was moderately correlated with State-Trait Anxiety Inventory-Children at T1 (r = 0.54, P < .01) and T2 (r = 0.56, P < .01). CONCLUSIONS: The Turkish version of CPMAS has good reliability and validity score. Therefore, it is a suitable instrument to assess perioperative anxiety in 7 to 13 years old children in a clinical setting.

Use of Therapeutic Plasma Exchange in the Pediatric Intensive Care Unit.

OBJECTIVE: Therapeutic plasma exchange has been used as a primary or supportive treatment in many diseases in recent years and has achieved satisfactory results in lots of diseases in children. Therapeutic plasma exchange procedure is changing plasma component of a patient's blood with the new plasma as a replacement solution. The aim of this study is to share our experience of therapeutic plasma exchange on varying indications in critically ill children who were accepted to our pediatric intensive care unit. MATERIALS AND METHODS: We conducted this study between December 2010 and February 2020, retrospectively. Patients' data such as age, sex, indication, number of sessions, vascular access route, and type of replacement fluid used were obtained from medical records. Indications for therapeutic plasma exchange were classified according to the 2019 American Society for Apheresis categorization. The patient's follow-up, clinical courses, therapeutic plasma exchange season count, complications, and outcome were evaluated according to each indications and their overall condition. RESULTS: This study included a total of the 84 patients who underwent therapeutic plasma exchange, and their median (minimum-maximum) ages were 7.07 years (0.2-18), 57.1% were male (n = 48) and 42.9% were female (n = 36). A total of 463 sessions of therapeutic plasma exchange were performed in 84 patients. The most common indication was thrombocytopenia-associated multi-organ failure with sepsis (40.4%, n = 34) followed by liver failure/hepatic encephalopathy (28.5%, n = 24) and autoimmune encephalitis (9.5%, n = 8), and according to The American Society for Apheresis 2019 category, patients distributions were as follows: 15.4% of the patients were placed in category 1 (n = 13), 5.9% in category 2 (n = 5), 77.3% in category 3 (n = 65), and 1.1% in category 4 (n = 1). Therapeutic plasma exchange was combined to extracorporeal membrane oxygenation in 10 patients (11.9%) and continuous renal replacement therapies in 39 (46.4%) patients. Finally, the survival rate was 50% in all patients, and the lowest survival rate was 41.5% (n = 27) in category 3 group. CONCLUSION: Therapeutic plasma exchange is enlarging to varying indications and showing to be more effective on a lot of disorders in children. Also, it is available in pediatric age groups and in different states like combined with other extracorporeal therapies.

Information, attitudes and behavior of Turkish people concerning COVID-19.

INTRODUCTION: This study aims to evaluate the knowledge, attitudes and behavior of people towards COVID-19 and to evaluate compliance with practices such as social isolation, curfews, mask use and hand hygiene. METHODOLOGY: A month after the COVID-19 infection was observed in Turkey, a standard questionnaire link was sent to participants via the online questionnaire platform to determine the knowledge, attitude, and behavior of the public. The survey results of 503 people were evaluated. RESULTS: During the COVID-19 pandemic 81.2% of the participants stayed at home, 79.1% of the participants wore a mask, 74% of the participants expressed to be following social distancing rules, 54.1% confirmed the use of hand sanitizers and 43.9% confirmed the use of gloves (43.9%), which are considered to be personal protective measures. The knowledge of terms such as 'quarantine' and 'isolation' was 94% and 97.4% respectively and 37.2% of the participants were of the opinion that the COVID-19 virus was produced in a laboratory environment. Within the research group, a rate of 65.6% of the participants found their own knowledge of COVID-19 to be sufficient. The participants found the announcements of official institutions more reliable than the announcements on television programs, the internet and social media. CONCLUSIONS: The public information on COVID-19 was found to be sufficient. In order to prevent the spreading of the pandemic, participants were partially compliant to rules such as staying at home, using masks, maintaining hand hygiene and social isolation. Compared to men, women's use of protective equipment was higher.